There are a limited number of case reports published describing the use of AfLT in various patient populations (). The majority of case reports describe AfLT experience in pediatric patients, ranging from infants to 18 years of age, but there are a few cases in adult patients. Among the case reports, the most commonly isolated fungi was C. albicans (9 of the 22 cases) followed by C. parapsilosis (4 of 22 cases). C. glabrata (2 cases), C. tropicalis (1 case), Candida guillermondii (1 case), and Candida lipolytica (1 case) were isolated less frequently.
Patient reports of AfLT against various fungal isolatesa
The most commonly employed Af
LT was d-AmB, with a combined catheter salvage rate of 76.9% (10 of 13 cases). Krzywda et al. reported using a significantly lower dose of d-AmB (0.33 mg/ml) compared to those used in other studies, which may have contributed to unsuccessful catheter salvage in all 5 episodes of fungemia in 2 patients (68
). L-AmB Af
LT was associated with a 60% (3 of 5 cases) salvage rate. In the only report of echinocandin lock therapy in the literature, CAS (3.33 mg/ml) combined with systemic CAS for 14 days was used to successfully treat C. lipolytica
). Blackwood et al. reported the successful use of a 70% EtOH lock solution for catheter salvage in three pediatric patients with invasive candidiasis (70
AfLT was most commonly employed for 14 days (using various instillation times) after the last negative blood culture in conjunction with systemic antifungal therapy. A wide variety of catheter types are described and do not appear to play a role in directing the type of AfLT that was utilized or duration of therapy.
There were a few patients with multiple recurrences of candidemia, requiring multiple attempts at treatment and catheter salvage. In some cases, the patient was apparently successfully treated the first time but developed a recurrent infection, necessitating catheter removal. Regardless of the type of AfLT used and systemic antifungal therapy, the overall clinical catheter salvage rate reported in the literature is 77%. Although the outcomes presented in these case reports are encouraging, these data need to be interpreted with caution, due to the effects of publication bias and lack of a true “denominator” of cases.